RA and Your Eyes: What You Need to Know

Rheumatoid arthritis is known for joint pain, but it can also affect other parts of the body, including your eyes. Learn which rheumatoid arthritis symptoms and eye issues are most common, and how to manage them.

Most people think of rheumatoid arthritis as a joint disease, but like other autoimmune disorders, it can impact different areas of the body as well. One of the more common complications for people with rheumatoid arthritis is eye problems, which can lead to corneal damage and ultimately impact vision if left untreated.

Some common eye conditions, like the ones described below, may affect people with rheumatoid arthritis (RA). But there are steps to take to safeguard eye health and avoid permanent damage.

Dry Eyes

“RA can be associated with extra-articular [meaning outside the joint] manifestations, and dry eyes are one of the most common problems,” says Ana-Maria Orbai, MD, instructor of medicine in the division of rheumatology at the Johns Hopkins University School of Medicine in Baltimore. “A person with dry eyes might experience itching, a sand-like sensation in the eyes, and redness.” They may also notice a lack of moisture or tears in the eyes, as well as blurred vision.

Although many people turn to over-the-counter eye drops for relief, the best treatment for dry eyes is prescription drops, which you can get from your ophthalmologist, Dr. Orbai says. A doctor who specializes in medical care of eyes, whereas an optometrist focuses primarily on vision problems, this eye MD can prescribe the right kind of eye medication for different uses (day versus night, for instance).

If you decide to go the over-the-counter route, avoid eye-drop products that have preservatives or vasoconstrictive agents, such as some from Visine and Clear Eyes, which often promise to relieve redness or “take the red out,” Orbai explains.

If your dry eyes are severe, your doctor might discuss the option of punctal plugs, a minor procedure that entails having a small plug inserted into the tear duct to keep the eye from draining. Your doctor may also prescribe Restasis (cyclosporine) drops.

Scleritis

Scleritis is an inflammation of the sclera, the white outer layer of the eye. Symptoms can include pain (sometimes severe), swelling, redness, blurred vision, tearing, and sensitivity to light. If you experience any of these issues, you should be evaluated by your ophthalmologist, Orbai says. And don’t delay seeking treatment. “Time is of the essence to prevent eye damage and vision loss,” she says. If it ends up being scleritis, your ophthalmologist may prescribe corticosteroid eye drops and possibly immunomodulator medications, she says.

Iritis and Uveitis

A quick anatomy lesson: The uvea is the middle part of the eye between the sclera and retina, which is in the back of the eye. The iris is the colored part of the eye that helps control how much light enters.

Uveitis is an inflammation of the uvea; iritis, a form of uveitis, is an inflammation of the iris. Symptoms include blurred vision; dark, floating spots in your vision; eye pain; redness; and sensitivity to light.

Treatment for either condition depends on the symptoms, Orbai explains. “Some options include corticosteroids, Trexall (methotrexate), Humira (adalimumab), and Remicade (infliximab). Your ophthalmologist will determine the right course of treatment for you based on your symptoms.

Medication Complications

Some of the medications used to treat rheumatoid arthritis, such as prednisone (a corticosteroid) and Plaquenil (hydroxychloroquine), can actually trigger eye problems. “Plaquenil, on rare occasions, can cause retinopathy,” says Orbai — an inflammatory disease of the retina that can lead to impairment or loss of vision. And prednisone can cause cataracts or glaucoma, or worsen these conditions if you already have them.

“People who need to take medications that have side effects that impact the eye should see an ophthalmologist who can monitor for adverse effects,” says Orbai. “For example, patients using Plaquenil should be seen yearly to rule out retinopathy.” If they do develop the condition, the doctor may decrease the dosage or stop the medication. “The most important precaution is to minimize duration of treatment: Take the least amount for the shortest time,” Orbai says.

The Bottom Line for Your Eyes

Anyone living with RA should see an ophthalmologist yearly, Orbai recommends. “Only an ophthalmologist can diagnose and rule out possible eye problems in people with RA,” she says.

People with RA should also visit an ophthalmologist if they experience any eye symptoms, such as itching, foreign body sensation, redness, pain, or vision loss.

Finally, it’s important to note that other conditions like acne and rosacea can lead to eye problems, Orbai points out. It’s good for people with RA to be aware of this, although it’s still critical to see your doctor if you’re experiencing any symptoms.